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Wang HF, Wang CY, Zhou XF, Deng XF, Huang H, Wang J, Chen XQ, Zhai ZF. A New Assessment Method of Vitiligo by Combination of Dermoscopy and Reflectance Confocal Microscopy. Clin Cosmet Investig Dermatol 2023; 16:3615-3623. [PMID: 38144155 PMCID: PMC10740724 DOI: 10.2147/ccid.s432169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/04/2023] [Indexed: 12/26/2023]
Abstract
Purpose The aim is to investigate the application value of dermoscopy combined with reflectance confocal microscopy (RCM) in assessing vitiligo disease activity and treatment response. Patients and Methods We enrolled 279 patients with vitiligo and evaluated the disease activity by Vitiligo Disease Activity (VIDA) score, dermoscopy, RCM and dermoscopy combined with RCM respectively. The sensitivity and specificity of different assessment techniques were compared with VIDA score by the differences and consistency. The different characteristics of dermoscopy and RCM with different treatment responses were also analyzed. Results The results showed that the sensitivity and specificity of dermoscopy combined RCM were higher than RCM or dermoscopy alone (P values less than 0.05). In the repigmentation process, leukotrichia, pigment network absent and perilesional hyperpigmentation under dermoscopy at the baseline suggested a poor treatment response, while the incompletely disappearing pigment rings under RCM and perifollicular hyperpigmentation under dermoscopy indicated a good treatment response. We also found the proportion of patients with telangiectasia, increased pigment at the lesions and around the hair follicles was significantly higher in the good treatment response group than that in the poor one by dermoscopy (χ2 = 4.423, 32.471, 4.348, P = 0.035 0.000, 0.037) and by RCM the proportion of patients with both increased pigment granules and dendritic melanocytes in the good treatment response group was higher than that in the poor one (χ2 = 38.215, 5.283, P = 0.000, 0.022, respectively). Conclusion With the higher sensitivity and specificity than dermoscopy or RCM alone, a combination of dermoscopy and RCM may be a new more accurate measure to assess the vitiligo disease activity and the treatment response.
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Affiliation(s)
- Hui-Fen Wang
- Department of Dermatology, the First Affiliated Hospital of Army Medical University, Chongqing, People’s Republic of China
| | - Chun-You Wang
- Department of Dermatology, the First Affiliated Hospital of Army Medical University, Chongqing, People’s Republic of China
| | - Xiao-Fang Zhou
- Department of Dermatology, the First Affiliated Hospital of Army Medical University, Chongqing, People’s Republic of China
| | - Xiang-Fen Deng
- Department of Dermatology, the First Affiliated Hospital of Army Medical University, Chongqing, People’s Republic of China
| | - Hui Huang
- Department of Dermatology, the First Affiliated Hospital of Army Medical University, Chongqing, People’s Republic of China
| | - Juan Wang
- Department of Dermatology, the First Affiliated Hospital of Army Medical University, Chongqing, People’s Republic of China
| | - Xue-Qin Chen
- Department of Dermatology, the First Affiliated Hospital of Army Medical University, Chongqing, People’s Republic of China
| | - Zhi-Fang Zhai
- Department of Dermatology, the First Affiliated Hospital of Army Medical University, Chongqing, People’s Republic of China
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Refat MA, Strassner JP, Frisoli ML, Rashighi M, Richmond J, Nada E, Saleh R, El-Hamd MA, Goldberg D, Mahmoud BH, Harris JE. Lesional CD8+ T-Cell Number Predicts Surgical Outcomes of Melanocyte-Keratinocyte Transplantation Surgery for Vitiligo. J Invest Dermatol 2023; 143:2275-2282.e6. [PMID: 37478900 PMCID: PMC11140410 DOI: 10.1016/j.jid.2023.03.1689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/05/2023] [Accepted: 03/20/2023] [Indexed: 07/23/2023]
Abstract
The melanocyte-keratinocyte transplantation procedure (MKTP) treats stable and recalcitrant vitiligo. Despite careful selection of candidates based on clinical stability, the success of the procedure is unpredictable. The aim of our study was to define the immunological profile of stable vitiligo lesions undergoing MKTP and correlate them with clinical outcomes. We included 20 MKTP candidates with vitiligo and a patient with piebaldism as a control. Prior to MKTP, T-cell subsets and chemokines in the recipient skin were measured by flow cytometry and ELISA. During MKTP, melanocytes in the donor skin were quantified by flow cytometry. After MKTP, patients were followed for 12 months and repigmentation was assessed clinically and by ImageJ analysis of clinical photographs. Baseline immunologic biomarkers, duration of clinical stability, and transplanted melanocyte number were correlated to postsurgical repigmentation scores. CD8+ T cells were elevated in 43% of the clinically stable vitiligo lesions. CD8+ T-cell number negatively correlated with postsurgical repigmentation scores (r = -0.635, P = 0.002). Duration of clinical stability, skin chemokines, and transplanted melanocyte number did not influence postsurgical repigmentation. This study demonstrates that CD8+ T-cell number correlates negatively with success of postsurgical repigmentation and can be a biomarker to identify ideal surgical candidates.
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Affiliation(s)
- Maggi A Refat
- Department of Dermatology, UMass Chan Medical School, Worcester, Massachusetts, USA; Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - James P Strassner
- Department of Dermatology, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Michael L Frisoli
- Department of Dermatology, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Mehdi Rashighi
- Department of Dermatology, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Jillian Richmond
- Department of Dermatology, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Essam Nada
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Ramadan Saleh
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Mohammed Abu El-Hamd
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Dori Goldberg
- Department of Dermatology, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Bassel H Mahmoud
- Department of Dermatology, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - John E Harris
- Department of Dermatology, UMass Chan Medical School, Worcester, Massachusetts, USA.
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Kamath C, Dhurat R, Shah B, Sharma R, Kowe PA, Chamle S. Monitoring of Vitiligo Patches Over Six Months to Validate Dermoscopic Findings of Lesional Stability. Dermatol Pract Concept 2023; 13:dpc.1304a277. [PMID: 37992385 PMCID: PMC10656188 DOI: 10.5826/dpc.1304a277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 11/24/2023] Open
Abstract
INTRODUCTION Previously laid down criteria for lesional stability of vitiligo are inconsistent. Longitudinal data on correlation between dermoscopic features of vitiligo and disease activity is limited. OBJECTIVES To sequentially determine the dermoscopic features of vitiligo and to assess their association with the dynamic nature of the vitiligo patch. METHODS Sixty patients with 200 vitiligo patches fulfilling the inclusion criteria on medical therapy were subjected to sequential clinical and dermoscopic examination for 6 months. Baseline lesional photographs, dermoscopy and tracing of the patch was made and repeated at 6 months. The follow up tracing was superimposed onto the baseline tracing. Based on the increase or decrease in size, their outcomes were grouped as responsive, progressive and quiescent. Paired analysis of dermoscopic features was done between baseline, and their follow up after 6 months. RESULTS Well defined border was associated with static nature of the vitiligo patch and ill-defined borders and trichrome pattern depicted its dynamic nature. Statistically significant increase in leukotrichia and satellite lesions amongst progressive patches and a decrease amongst responsive patches was observed. Pigment network changes were statistically significant for both responsive and progressive patches. Satellite lesions and micro-Koebner's phenomena was suggestive of progressive disease, while perifollicular pigmentation and perilesional hyperpigmentation was suggestive of re-pigmenting disease and proved to be an early marker for response to therapy. CONCLUSIONS Repeated dermoscopic evaluation of lesions in a serial manner to assess disease activity helps understand their evolving nature and is a valuable tool in planning appropriate further treatment.
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Affiliation(s)
- Chitra Kamath
- Department of Dermatology, Venerology and Leprosy, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Rachita Dhurat
- Department of Dermatology, Venerology and Leprosy, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Bhavika Shah
- Department of Dermatology, Venerology and Leprosy, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Richa Sharma
- Department of Dermatology, Venerology and Leprosy, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Priyanka Arun Kowe
- Department of Dermatology, Venerology and Leprosy, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Sachin Chamle
- Department of Dermatology, Venerology and Leprosy, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
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Terry MB, Colditz GA. Epidemiology and Risk Factors for Breast Cancer: 21st Century Advances, Gaps to Address through Interdisciplinary Science. Cold Spring Harb Perspect Med 2023; 13:a041317. [PMID: 36781224 PMCID: PMC10513162 DOI: 10.1101/cshperspect.a041317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Research methods to study risk factors and prevention of breast cancer have evolved rapidly. We focus on advances from epidemiologic studies reported over the past two decades addressing scientific discoveries, as well as their clinical and public health translation for breast cancer risk reduction. In addition to reviewing methodology advances such as widespread assessment of mammographic density and Mendelian randomization, we summarize the recent evidence with a focus on the timing of exposure and windows of susceptibility. We summarize the implications of the new evidence for application in risk stratification models and clinical translation to focus prevention-maximizing benefits and minimizing harm. We conclude our review identifying research gaps. These include: pathways for the inverse association of vegetable intake and estrogen receptor (ER)-ve tumors, prepubertal and adolescent diet and risk, early life adiposity reducing lifelong risk, and gaps from changes in habits (e.g., vaping, binge drinking), and environmental exposures.
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Affiliation(s)
- Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University, Chronic Disease Unit Leader, Department of Epidemiology, Herbert Irving Comprehensive Cancer Center, Associate Director, New York, New York 10032, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine and Alvin J. Siteman Cancer Center at Washington University School of Medicine and Barnes-Jewish Hospital in St Louis, St. Louis, Missouri 63110, USA
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5
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Pektaş SD, Kara M, Doğan G, Pektaş MB, Baloğlu MC, Sadi G. Differential Expression and in Silico Functional Analysis of Plasma MicroRNAs in the Pathogenesis of Non-segmental Vitiligo. Indian J Dermatol 2022; 67:705-714. [PMID: 36998849 PMCID: PMC10043660 DOI: 10.4103/ijd.ijd_383_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
Vitiligo is a disease characterized by acquired depigmentation, white macules, and patches on the skin due to the dysfunction of epidermal melanocytes. In this study, we attempt to profile the microRNA (miRNA) expression patterns and predict the potential targets, assessing the biological functions of differentially expressed miRNAs in the blood of generalized vitiligo patients. Peripheral blood samples were taken from all participants, and the expression levels of 89 identified miRNAs were analyzed with real-time quantitative polymerase chain reaction (PCR). The results indicated significant upregulation of six miRNAs and downregulation of 19 miRNAs in the plasma of vitiligo patients. The top three upregulated miRNAs were hsa-miR-451a, hsa-miR-25-3p, and hsa-miR-19a-3p, and the top three downregulated miRNAs were hsa-miR-146a-5p, hsa-miR-940, and hsa-miR-142-3p. Moreover, the miRNA expression profiles of patients with Type 3 and Type 4 phototypes were substantially different in such a way that the patients with Type 3 phototype would be more prone to the emergence of melanoma and cancer. While significant variations in the expression patterns of miRNAs in male and female vitiligo patients were demonstrated, miR-let-7i-5p, miR-19a-3p, miR-25-3p, and miR-451a were commonly upregulated, and miR-142-3p and miR-146a-5p were commonly repressed in both sexes. This study may shed light on the roles of differentially expressed miRNAs in vitiligo patients by examining the miRNA expression patterns and the combined effects of miRNA and their predicted targets.
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Affiliation(s)
- Suzan Demir Pektaş
- Department of Dermatology, Faculty of Medicine, Muğla Sıtkı Koçman University, Mugla, Turkey
| | - Murat Kara
- Department of Dermatology, Faculty of Medicine, Muğla Sıtkı Koçman University, Mugla, Turkey
| | - Gürsoy Doğan
- Department of Dermatology, Faculty of Medicine, Muğla Sıtkı Koçman University, Mugla, Turkey
| | - Mehmet Bilgehan Pektaş
- Department of Pharmacology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Kastamonu, Turkey
| | - Mehmet Cengiz Baloğlu
- Department of Genetics and Bioengineering, Engineering Faculty, Kastamonu University, Kastamonu, Turkey
| | - Gökhan Sadi
- Department of Biology, K. Ö. Science Faculty, Karamanoğlu Mehmetbey University, Karaman, Turkey
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Shabaka FH, Rashed LA, Said M, Ibrahim L. Sensitivity of serum S100B protein as a disease activity marker in Egyptian patients with vitiligo (case-control study). Arch Physiol Biochem 2022; 128:930-937. [PMID: 32188291 DOI: 10.1080/13813455.2020.1739717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Vitiligo is a depigmented skin disease. S100B is a damage-associated molecular pattern protein proposed as a marker of melanocyte cytotoxicity. AIM To detect the sensitivity of serum levels of S100B as a disease activity marker in vitiligo patients. METHODS Four patient groups of both sexes: twenty segmental vitiligo, twenty non-segmental active vitiligo patients, twenty non-segmental stable vitiligo patients and thirty healthy controls age and sex-matched, patients were subjected to vitiligo disease activity score (VIDA score) and Vitiligo Extent Tensity Index (VETI) score. RESULTS An increased level of S100B was observed in patients with vitiligo compared to control, there was statistically significant increase in its level in non- segmental-active than non-segmental stable and segmental-stable. Roc analysis for S100B to predict cases vs control was confirmed by getting cut off point 80.2 pg/ml, with high sensitivity 96.67 and high specificity 96.67. Roc analysis for S100B to predict non-segmental-active versus segmental and non-segmental was also confirmed by getting cut off point 118.3 pg/ml, with sensitivity 80.0 and specificity 77.50. CONCLUSION S100B can be used as indicators for disease activity with high sensitivity and specificity in Egyptian vitiligo patients.
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Affiliation(s)
- Fatma H Shabaka
- Department of Dermatology and Venereology, Faculty of Medicine (for girls), Al-Azhar University, Cairo, Egypt
| | - Laila A Rashed
- Department of Biochemistry, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Marwa Said
- Department of Dermatology and Venereology, Faculty of Medicine (for girls), Al-Azhar University, Cairo, Egypt
| | - Lobna Ibrahim
- Department of Dermatology and Venereology, Faculty of Medicine (for girls), Al-Azhar University, Cairo, Egypt
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7
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Shiu J, Zhang L, Lentsch G, Flesher JL, Jin S, Polleys CM, Jo SJ, Mizzoni C, Mobasher P, Kwan J, Rius-Diaz F, Tromberg BJ, Georgakoudi I, Nie Q, Balu M, Ganesan AK. Multimodal analyses of vitiligo skin identifies tissue characteristics of stable disease. JCI Insight 2022; 7:154585. [PMID: 35653192 PMCID: PMC9310536 DOI: 10.1172/jci.insight.154585] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 05/25/2022] [Indexed: 11/24/2022] Open
Abstract
Vitiligo is an autoimmune skin disease characterized by the destruction of melanocytes by autoreactive CD8+ T cells. Melanocyte destruction in active vitiligo is mediated by CD8+ T cells, but the persistence of white patches in stable disease is poorly understood. The interaction between immune cells, melanocytes, and keratinocytes in situ in human skin has been difficult to study due to the lack of proper tools. We combine noninvasive multiphoton microscopy (MPM) imaging and single-cell RNA-Seq (scRNA-Seq) to identify subpopulations of keratinocytes in stable vitiligo patients. We show that, compared with nonlesional skin, some keratinocyte subpopulations are enriched in lesional vitiligo skin and shift their energy utilization toward oxidative phosphorylation. Systematic investigation of cell-to-cell communication networks show that this small population of keratinocyte secrete CXCL9 and CXCL10 to potentially drive vitiligo persistence. Pseudotemporal dynamics analyses predict an alternative differentiation trajectory that generates this new population of keratinocytes in vitiligo skin. Further MPM imaging of patients undergoing punch grafting treatment showed that keratinocytes favoring oxidative phosphorylation persist in nonresponders but normalize in responders. In summary, we couple advanced imaging with transcriptomics and bioinformatics to discover cell-to-cell communication networks and keratinocyte cell states that can perpetuate inflammation and prevent repigmentation.
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Affiliation(s)
- Jessica Shiu
- Department of Dermatology, University of California, Irvine, Irvine, United States of America
| | - Lihua Zhang
- Department of Mathematics, University of California, Irvine, Irvine, United States of America
| | - Griffin Lentsch
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, United States of America
| | - Jessica L Flesher
- Department of Dermatology, Massachusetts General Hospital, Boston, United States of America
| | - Suoqin Jin
- Department of Mathematics, University of California, Irvine, Irvine, United States of America
| | - Christopher M Polleys
- Department of Biomedical Engineering, Tufts University, Medford, United States of America
| | - Seong Jin Jo
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea, Republic of
| | - Craig Mizzoni
- Department of Biomedical Engineering, Tufts University, Medford, United States of America
| | - Pezhman Mobasher
- Department of Dermatology, University of California, Irvine, Irvine, United States of America
| | - Jasmine Kwan
- Department of Biomedical Engineering, Tufts University, Medford, United States of America
| | - Francisca Rius-Diaz
- Department of Preventive Medicine and Public Health, University of Malaga, Malaga, Spain
| | - Bruce J Tromberg
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, United States of America
| | - Irene Georgakoudi
- Department of Biomedical Engineering, Tufts University, Medford, United States of America
| | - Qing Nie
- Department of Mathematics, University of California, Irvine, Irvine, United States of America
| | - Mihaela Balu
- Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, United States of America
| | - Anand K Ganesan
- Department of Dermatology, University of California, Irvine, Irvine, United States of America
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Vitiligo-specific soluble biomarkers as early indicators of response to immune checkpoint inhibitors in metastatic melanoma patients. Sci Rep 2022; 12:5448. [PMID: 35361879 PMCID: PMC8971439 DOI: 10.1038/s41598-022-09373-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 03/21/2022] [Indexed: 02/08/2023] Open
Abstract
Immunotherapy with checkpoint inhibitors (CPIs) strongly improved the outcome of metastatic melanoma patients. However, not all the patients respond to treatment and identification of prognostic biomarkers able to select responding patients is currently of outmost importance. Considering that development of vitiligo-like depigmentation in melanoma patients represents both an adverse event of CPIs and a favorable prognostic factor, we analyzed soluble biomarkers of vitiligo to validate them as early indicators of response to CPIs. Fifty-seven metastatic melanoma patients receiving CPIs were enrolled and divided according to the best overall response to treatment. Patient sera were evaluated at pre-treatment and after 1 and 3 months of therapy. We found that basal CD25 serum levels were higher in stable and responding patients and remained higher during the first 3 months of CPI therapy compared to non-responders. CXCL9 was absent in non-responding patients before therapy beginning. Moreover, an increase of CXCL9 levels was observed at 1 and 3 months of therapy for all patients, although higher CXCL9 amounts were present in stable and responding compared to non-responding patients. Variations in circulating immune cell subsets was also analyzed, revealing a reduced number of regulatory T lymphocytes in responding patients. Altogether, our data indicate that a pre-existing and maintained activation of the immune system could be an indication of response to CPI treatment in melanoma patients.
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Ismail SI, Hegazy RA, Gawdat HI, Esmat S, Mahmoud E, Rashed L, Hegazy AA, Saadi DG. Differentiating active from stable vitiligo: the role of dermoscopic findings and their relation to CXCL-10. J Cosmet Dermatol 2022; 21:4651-4658. [PMID: 35298096 DOI: 10.1111/jocd.14922] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/11/2021] [Accepted: 03/08/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Distinguishing vitiligo activity/stability status is pivotal in the management of patients with vitiligo. CXCL10 is a chemokine released in the tissues and sera of patients with vitiligo and an indicator of disease activity. AIM This study aimed to assess the role of dermoscopy in detecting active and stable vitiligo by comparing the dermoscopic signs in vitiligo with Vitiligo Disease Activity Score (VIDA) score, clinical activity, and CXCL10 activity. METHODS Ninety-seven patients with vitiligo were enrolled in this cross-sectional study. Vitiligo activity/stability was assessed using VIDA scores, clinical examination, dermoscopy, and serum CXCL10 levels measured by enzyme-linked immunosorbent assay technique. Dermoscopic scores were calculated using BPLeFoSK score. RESULTS The dermoscopic score was concordant with the VIDA score in 83.5% of patients (n = 81), clinical assessment in 97.9% (n = 95), and serum CXCL10 level in 70.1% (n = 68). Dermoscopic signs of ill-defined border, satellite lesions, and micro-Koebner and starburst appearance were more common in active vitiligo, while a well-defined border was more common in stable lesions. CONCLUSION Dermoscopic examination is a practical, reliable, noninvasive, semi-objective tool in the assessment of vitiligo activity/stability that helps reach an informed decision on the disease status to choose the appropriate therapeutic modality.
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Affiliation(s)
- Sarah I Ismail
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rehab A Hegazy
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Heba I Gawdat
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Samia Esmat
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Esraa Mahmoud
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Laila Rashed
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amira Aly Hegazy
- Public Health and Community Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dina G Saadi
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
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10
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Tyagi S, Malhotra SK, Kaur T. Comparative Evaluation of Efficacy of Non-cultured Epidermal Cell Suspension and Epidermal Curettage in Stable Vitiligo. J Cutan Aesthet Surg 2021; 14:32-40. [PMID: 34084006 PMCID: PMC8149990 DOI: 10.4103/jcas.jcas_190_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Vitiligo is a common primary acquired pigmentary disorder due to loss of epidermal functioning melanocytes. Many surgical techniques have evolved over the years for its treatment and the need of a cost-effective modality has always been put forward. AIM The aim of the study was to compare the efficacy of non-cultured epidermal cell suspension with that of epidermal curettage in repigmentation of stable vitiligo. SETTINGS AND DESIGN It was a prospective randomized non-controlled study. SUBJECTS AND METHODS Forty lesions were selected in patients of stable, recalcitrant vitiligo belonging to different age-groups and genders. After histopathological confirmation, the patients were taken up for surgery after obtaining written consent and were divided into two groups for two different procedures, that is, non-cultured epidermal cell suspension (Group A) and epidermal curettage (Group B). Follow-up was carried out at 2, 4, 8, and 12 weeks of procedure to assess the repigmentation achieved. STATISTICAL ANALYSIS Statistical Package for Social Sciences (SPSS) software, version 21.0, was used. RESULTS At the end of the study, >50% repigmentation was achieved in 95% (19 of 20) lesions of Group A and 85% (17 of 20) lesions in Group B, whereas >75% repigmentation was achieved in 60% (12 of 20) in both Groups A and B. The color matching with surrounding skin and yield of graft was better in epidermal cell suspension technique than that in epidermal curettage. The difference was not statistically significant. CONCLUSION Though both the surgical techniques of melanocyte transplantation are effective in achieving uniform pigmentation, epidermal curettage has an extra edge of being simpler and more cost-effective.
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Affiliation(s)
- Shashank Tyagi
- Department of Dermatology, Government Medical College, Amritsar, Punjab, India
| | - Suresh K. Malhotra
- Department of Dermatology, Government Medical College, Amritsar, Punjab, India
| | - Tejinder Kaur
- Department of Dermatology, Government Medical College, Amritsar, Punjab, India
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11
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Dellatorre G, Antelo DAP, Bedrikow RB, Cestari TF, Follador I, Ramos DG, Silva de Castro CC. Consensus on the treatment of vitiligo - Brazilian Society of Dermatology. An Bras Dermatol 2020; 95 Suppl 1:70-82. [PMID: 33153826 PMCID: PMC7772607 DOI: 10.1016/j.abd.2020.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/15/2020] [Indexed: 01/20/2023] Open
Abstract
Background Vitiligo is a muco-cutaneous, autoimmune, localized, or disseminated disease, which manifests through hypochromic or achromic macules, with loss in quality of life. The prevalence of vitiligo in Brazil was determined to be 0.54%. There is no on-label medication for its treatment. To date, no Brazilian consensus on the treatment of vitiligo had been written. Objectives The objective of this group of Brazilian dermatologists with experience in the treatment of this disease was to reach a consensus on the clinical and surgical treatment of vitiligo, based on articles with the best scientific evidence. Methods Seven dermatologists were invited, and each was assigned two treatment modalities to review. Each treatment (topical, systemic, and phototherapy) was reviewed by three experts. Two experts reviewed the surgical treatment. Subsequently, the coordinator compiled the different versions and drafted a text about each type of treatment. The new version was returned to all experts, who expressed their opinions and made suggestions for clarity. The final text was written by the coordinator and sent to all participants to prepare the final consensus. Results/Conclusion The experts defined the following as standard treatments of vitiligo: the use of topical corticosteroids and calcineurin inhibitors for localized and unstable cases; corticosteroid minipulse in progressive generalized vitiligo; narrowband UVB phototherapy for extensive forms of the disease. Surgical modalities should be indicated for segmental and stable generalized vitiligo. Topical and systemic anti-JAK drugs are being tested, with promising results.
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Affiliation(s)
- Gerson Dellatorre
- Department of Dermatology, Hospital Santa Casa de Misericórdia de Curitiba, Curitiba, PR, Brazil
| | | | | | - Tania Ferreira Cestari
- Department of Dermatology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Daniel Gontijo Ramos
- Department of Dermatology, Santa Casa de Misericórdia de Belo Horizonte, Belo Horizonte, MG, Brazil
| | - Caio Cesar Silva de Castro
- Department of Dermatology, Faculty of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil.
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12
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The impact of NBUVB on microbial community profiling in the lesional skin of vitiligo subjects. Microb Pathog 2020; 140:103943. [PMID: 31917273 DOI: 10.1016/j.micpath.2019.103943] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/10/2019] [Accepted: 12/20/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND The impact of NBUVB on the cutaneous microbiota of vitiligo patients remains to be fully elucidated. METHODS To characterize the cutaneous microbiota in vitiligo patients, cutaneous samples from 60 patients with vitiligo and after NBUVB irradiation were profiled using the Illumina MiSeq platform. Alpha diversity estimations revealed higher microbiota diversity in samples from patients with lesional skin. Beta diversity (Principal Component Analysis (PCA)) analysis showed that the bacterial community structure segregated differently between different groups. RESULTS There was a statistically significant increase in the Sobs, ACE, and Chao indices in the NB group compared with NF group, as determined by t-test. The alpha diversity have no significant difference between NF and DB group. At the phylum level, Firmicutes, Proteobacteria and Actinobacteria were the most predominant phyla. Propionibacterium and Pseudomonas were the most predominant genera in each group. In addition, Staphylococcus, Bacillus and Prevotella were enriched in DF group compared to DB group. Propionibacterium was enriched in DB group compared to DF group. CONCLUSIONS Our studies indicate differences in microbial community dynamics of the lesional and non-lesional sites of vitiligo subjects, with greater diversity and higher association between microbial communities of the unaffected site. And NBUVB irradiation might eliminate these differences.
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13
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Chuah SY, Thng STG. The role of in vivo reflectance confocal microscopy in assessing the stability of vitiligo vulgaris prior to cellular grafting. Skin Res Technol 2018; 25:245-247. [DOI: 10.1111/srt.12638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 09/24/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Sai Yee Chuah
- Department of DermatologyNational Skin Centre Singapore Singapore
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14
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Dellatorre G, Bertolini W, Castro CCSD. Optimizing suction blister epidermal graft technique in the surgical treatment of vitiligo. An Bras Dermatol 2018; 92:888-890. [PMID: 29364459 PMCID: PMC5786417 DOI: 10.1590/abd1806-4841.20176332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 12/30/2016] [Indexed: 12/03/2022] Open
Abstract
Surgical management of vitiligo is considered an excellent terapeutic option for
recalcitrant cases, provided the disease is stable and there is absence of
Koebner phenomenom. Among surgical modalities, Suction Blister Epidermal Graft
is a low cost and effective option (65 to 100% repigmentation can be achieved in
up to 80% of patients). We describe how it can be optimized by using an
alternative suction equipment, by customization of graft format and by
application of an anesthetic technique that substantially reduces procedure
time.
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Affiliation(s)
- Gerson Dellatorre
- Department of Dermatology at Hospital Santa Casa de Curitiba - Curitiba (PR), Brazil
| | - Wagner Bertolini
- Department of Dermatology of the Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) - Porto Alegre (RS), Brazil
| | - Caio Cesar Silva de Castro
- Department of Dermatology at Hospital Santa Casa de Curitiba - Curitiba (PR), Brazil.,Pontifícia Universidade Católica do Paraná (PUCPR) - Curitiba (PR), Brazil
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15
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Dermoscopy as an evolving tool to assess vitiligo activity. J Am Acad Dermatol 2017; 78:1017-1019. [PMID: 29229577 DOI: 10.1016/j.jaad.2017.12.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/29/2017] [Accepted: 12/03/2017] [Indexed: 11/23/2022]
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16
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Abdallah M, El-Mofty M, Anbar T, Rasheed H, Esmat S, Al-Tawdy A, Fawzy MM, Abdel-Halim D, Hegazy R, Gawdat H, Bassiouny D, Ibrahim MA, Sany I, El-Bassiouny M, Khalil M, Abdel-Aziz A, El Maadawi ZM, Mostafa WZ. CXCL-10 and Interleukin-6 are reliable serum markers for vitiligo activity: A multicenter cross-sectional study. Pigment Cell Melanoma Res 2017; 31:330-336. [DOI: 10.1111/pcmr.12667] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 10/07/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Marwa Abdallah
- Dermatology, Venereology and Andrology Department; Ain Shams University; Cairo Egypt
| | | | - Tag Anbar
- Dermatology and Venereology Department; Minya University; Al- Minya Egypt
| | - Hoda Rasheed
- Dermatology Department; Cairo University; Cairo Egypt
| | - Samia Esmat
- Dermatology Department; Cairo University; Cairo Egypt
| | | | | | | | - Rehab Hegazy
- Dermatology Department; Cairo University; Cairo Egypt
| | - Heba Gawdat
- Dermatology Department; Cairo University; Cairo Egypt
| | | | - Mona A. Ibrahim
- Dermatology, Venereology and Andrology Department; Ain Shams University; Cairo Egypt
| | - Iman Sany
- Dermatology Department; Cairo University; Cairo Egypt
| | - Mahy El-Bassiouny
- Dermatology, Venereology and Andrology Department; Ain Shams University; Cairo Egypt
| | - Mohamed Khalil
- Dermatology, Venereology and Andrology Department; Ain Shams University; Cairo Egypt
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17
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Benzekri L, Gauthier Y. Clinical markers of vitiligo activity. J Am Acad Dermatol 2017; 76:856-862. [DOI: 10.1016/j.jaad.2016.12.040] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 10/08/2016] [Accepted: 12/23/2016] [Indexed: 11/28/2022]
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18
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Alexeev V. CXCL12 as a Predictor of Vitiligo Activity and Disease Progression. J Invest Dermatol 2017; 137:1588-1590. [PMID: 28365260 DOI: 10.1016/j.jid.2017.03.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 03/14/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Vitali Alexeev
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
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19
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Majid I, Mysore V, Salim T, Lahiri K, Chatterji M, Khunger N, Talwar S, Sachhidanand S, Barua S. Is Lesional Stability in Vitiligo More Important Than Disease Stability for Performing Surgical Interventions? Results from a Multicentric Study. J Cutan Aesthet Surg 2016; 9:13-9. [PMID: 27081244 PMCID: PMC4812882 DOI: 10.4103/0974-2077.178538] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Ensuring stability of the disease process is essential for undertaking surgical intervention in vitiligo. However, there is no consensus regarding the minimum duration of stability or the relative importance of disease and lesional stability in selecting patients for vitiligo grafting. Aim: This multicentric study aims to assess the relative importance of lesional and disease stability on selecting patients for vitiligo grafting. Materials and Methods: One hundred seventy patients were recruited into the study and divided into two groups: Group A with lesional stability of >1 year but overall disease stability of only 6-11 months and Group B with overall disease stability of >1 year. Patients underwent either tissue or cellular vitiligo grafting on the selected lesions and the repigmentation achieved was scored from 0 (no repigmentation) to 6 (100% repigmentation). Repigmentation achieved on different sites of the body was compared between the two groups. Adverse effects at both the donor and the recipient sites were also compared. Results: Of the 170 patients who were enrolled, 82 patients were placed in Group A and 88 patients in Group B. Average repigmentation achieved (on scale of 0 to 6) was 3.8 and 4.04 in Group A and Group B, respectively. In Group A, ≥90% repigmentation was achieved in 36.6% (30/82) patients, while 37.5% (33/88) achieved similar results in Group B. Additionally, 47.6% (39/82) and 53.4% (47/88) of cases achieved partial repigmentation in Group A and Group B, respectively. Perigraft halo was the commonest adverse effect observed in both groups. Statistical analysis revealed no significant differences between the two groups with respect to the repigmentation achieved or adverse effects observed. Repigmentation achieved was the best on the face and neck area, while acral areas responded the least. Conclusions: Lesional stability seems to be as relevant as the overall disease stability in selecting patients for surgical intervention in vitiligo.
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Affiliation(s)
- Imran Majid
- CUTIS Institute of Dermatology, Srinagar, Kashmir, India
| | - Venkataram Mysore
- Venkat Charmalaya Centre for Advanced Dermatology and Postgraduate Training, Bangalore, India
| | - Thurakkal Salim
- Cutis Institute of Advanced Dermatology, Calicut, Kerala, India
| | | | | | - Niti Khunger
- Vardhman Mahavir Medical College, Safdarjung Hospital, Delhi, India
| | - Suresh Talwar
- Talwar Skin and Laser Centre, Lucknow, Uttar Pradesh, India
| | - S Sachhidanand
- Rajiv Gandhi University of Health Sciences, Bengaluru, Karnataka, India
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20
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Microbial community profiling shows dysbiosis in the lesional skin of Vitiligo subjects. Sci Rep 2016; 6:18761. [PMID: 26758568 PMCID: PMC4725359 DOI: 10.1038/srep18761] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 11/26/2015] [Indexed: 12/18/2022] Open
Abstract
Healthy human skin harbours a diverse array of microbes that comprise the skin microbiome. Commensal bacteria constitute an important component of resident microbiome and are intricately linked to skin health. Recent studies describe an association between altered skin microbial community and epidemiology of diseases, like psoriasis, atopic dermatitis etc. In this study, we compare the differences in bacterial community of lesional and non-lesional skin of vitiligo subjects. Our study reveals dysbiosis in the diversity of microbial community structure in lesional skin of vitiligo subjects. Although individual specific signature is dominant over the vitiligo-specific microbiota, a clear decrease in taxonomic richness and evenness can be noted in lesional patches. Investigation of community specific correlation networks reveals distinctive pattern of interactions between resident bacterial populations of the two sites (lesional and non-lesional). While Actinobacterial species constitute the central regulatory nodes (w.r.t. degree of interaction) in non-lesional skin, species belonging to Firmicutes dominate on lesional sites. We propose that the changes in taxonomic characteristics of vitiligo lesions, as revealed by our study, could play a crucial role in altering the maintenance and severity of disease. Future studies would elucidate mechanistic relevance of these microbial dynamics that can provide new avenues for therapeutic interventions.
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Garcia-Melendez ME, Salinas-Santander M, Sanchez-Dominguez C, Gonzalez-Cardenas H, Cerda-Flores RM, Ocampo-Candiani J, Ortiz-López R. Protein tyrosine phosphatase PTPN22 +1858C/T polymorphism is associated with active vitiligo. Exp Ther Med 2014; 8:1433-1437. [PMID: 25289035 PMCID: PMC4186394 DOI: 10.3892/etm.2014.1975] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 08/14/2014] [Indexed: 01/12/2023] Open
Abstract
Vitiligo is characterized by a skin depigmentation disorder resulting from an autoimmune response targeting melanocytes. Within the genetic factors involved in the development of the vitiligo immune response, various genes in the major histocompatibility complex (MHC) and non-MHC loci have been considered to be risk factors. The PTPN22 gene encodes for a lymphoid protein tyrosine phosphatase, a regulator of the activation and development of T-cells. The +1858C/T polymorphism has been associated to autoimmune disease susceptibility in different populations and could be implicated in the onset of vitiligo. To assess the possible association between the presence of PTPN22 +1858C/T and vitiligo, 187 patients with vitiligo and 223 control subjects were analyzed in the study. Genomic DNA was isolated using the salting-out method and samples were subjected to polymerase chain reaction-restriction fragment length polymorphism in order to detect the PTPN22 +1858C/T polymorphism. Causal associations were determined by χ2 test and their respective odds ratio (OR) was assessed in a 2×2 contingency table. The results showed an association between active vitiligo and the allele T load [P=0.0418; OR, 2.5706; 95% confidence interval (CI), 1.0040-6.5816], and active vitiligo-CT genotype (P=0.0389, OR, 2.6548; 95% CI, 1.0191-6.9156). In conclusion, the present data indicates a possible association between the PTPN22 +1858C/T genotype and a significant susceptibility of developing an active form of vitiligo.
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Affiliation(s)
- Martha Elena Garcia-Melendez
- Dermatology Service, Hospital Universitario 'Dr. José Eleuterio González', Monterrey, CP 64460, Nuevo León, Mexico
| | - Mauricio Salinas-Santander
- Department of Biochemistry and Molecular Medicine, Faculty of Medicine, Universidad Autónoma de Nuevo León, Monterrey, CP 64460, Nuevo León, Mexico ; Saltillo Unit Faculty of Medicine, Universidad Autónoma de Coahuila, Saltillo CP 25000, Coahuila, Mexico
| | - Celia Sanchez-Dominguez
- Department of Biochemistry and Molecular Medicine, Faculty of Medicine, Universidad Autónoma de Nuevo León, Monterrey, CP 64460, Nuevo León, Mexico
| | - Hugo Gonzalez-Cardenas
- Department of Biochemistry and Molecular Medicine, Faculty of Medicine, Universidad Autónoma de Nuevo León, Monterrey, CP 64460, Nuevo León, Mexico
| | - Ricardo M Cerda-Flores
- Nursery School Faculty, Universidad Autónoma de Nuevo León, Monterrey, CP 64460, Nuevo León, Mexico
| | - Jorge Ocampo-Candiani
- Dermatology Service, Hospital Universitario 'Dr. José Eleuterio González', Monterrey, CP 64460, Nuevo León, Mexico
| | - Rocío Ortiz-López
- Department of Biochemistry and Molecular Medicine, Faculty of Medicine, Universidad Autónoma de Nuevo León, Monterrey, CP 64460, Nuevo León, Mexico ; Molecular Biology, Genomics and Sequencing Unit, Center for Research and Development in the Health Sciences, Universidad Autónoma de Nuevo León, Monterrey, CP 64460, Nuevo León, Mexico
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